小儿异基因造血干细胞移植术后淋巴组织增殖性疾病临床特征及CT表现  

The CT Manifestations and Clinical Characteristics of Post-Transplant Lymphoproliferative Diseases after Allogeneic Hematopoietic Stem Cell Transplantation in Children

作　　者：徐守军[1] 杨春兰[2] 曹娟[3] 谢丽春 林飞飞[1] 王春静[2] 罗娜[1] XU Shoujun;YANG Chunlan;CAO Juan(Department of Radiology,Shenzhen Children's Hospital,Shenzhen,Guangdong Province 518026,P.R.China)

机构地区：[1]深圳市儿童医院放射科,518026 [2]深圳市儿童医院血液肿瘤科,518026 [3]深圳市儿童医院病理科,518026 [4]广州医科大学附属第三医院儿科,510530

出　　处：《临床放射学杂志》2024年第2期257-263,共7页Journal of Clinical Radiology

基　　金：广东省高水平临床重点专科项目(编号:SZGSP012);广东省基础与应用基础研究基金项目(编号:2022A1515111121);深圳市医学重点学科建设经费项目(编号:SZXK034);深圳市医疗卫生三名工程项目(编号:SZSM202011005);深圳市基础研究专项(自然科学基金)基础研究面上项目(编号:JCYJ20220530155616038)。

摘　　要：目的观察小儿异基因造血干细胞移植(HSCT)移植后淋巴组织增殖性疾病(PTLD)的临床特征及CT表现。方法回顾性分析2016年10月至2022年3月本院收治的21例PTLD患儿病例资料。确诊前所有病例均行CT平扫检查,10例平扫后行增强扫描。结果21例患儿均见结内组织受累,其中20例累及颈部/颌下淋巴结(其中9例同时累及腭扁桃体、2例累及腺样体),另外1例累及腹部多处淋巴结;结外组织受累5例(23.8%),其中肺部受累3例、胃壁受累1例、膀胱壁受累1例。按部位观察,颈部20例、肺部3例、腹部3例。移植与PTLD确诊间隔时间1~24个月,平均(4.67±5.61)个月。临床首次就诊原因主要为颈部包块、气道阻塞、腹痛、发热等,多伴有EB病毒(EBV)、巨细胞病毒(CMV)及乳酸脱氢酶(LDH)升高。1例确诊PTLD后5个月死亡;另有1例肺部PTLD病灶,短期内较前逐渐、快速增大;15例好转;由于病程较短,其余4例暂未随访。结论小儿PTLD具有较高的侵袭性,且小儿发病率明显高于成人,但预后优于成人;及时和准确的诊断对预后至关重要。临床与影像学检查相结合,有利于早期诊断。Objective To observe The CT manifestations and clinical characteristics of post-transplant lymphoproliferative diseases after allogeneic hematopoietic stem cell transplantation in children.Methods We conducted a retrospective analysis the case of 21 children with PTLD admitted to our hospital from October 2016 to March 2022.Before diagnosis,all cases received plain CT scan,and 10 cases received enhanced CT scan after plain scan.Results All the 21 cases were found to be involved in nodal tissue,including 20 cases involving cervical/submaxillary lymph nodes(9 cases involving palatine tonsils,2 cases involving adenoids among them at the same time),and 1 case involving multiple abdominal lymph nodes.Extranodal tissue was involved in 5 cases(23.8%),including pulmonary mass in 3 cases,gastric wall in 1 case and bladder wall in 1 case.By site observation,20 cases of neck,3 cases of lung and 3 cases of abdomen were involved.The average interval between transplantation and PTLD diagnosis was(4.67±5.61)months from 1 to 24 months.The main reasons for the first visit were neck mass,airway obstruction,abdominal pain,fever,etc.,often accompanied by elevated EBV,CMV and LDH.1 patient died 5 months after diagnosis of PTLD;In addition,there was 1 case of pulmonary PTLD lesion,which increased gradually and rapidly in the short term;15 cases improved;and due to the short course of the disease,the other 4 cases were not followed up.Conclusion PTLDs in children are highly invasive,and the incidence of PTLD in children is significantly higher than that in adults,but the prognosis is better than that in adults.Timely and accurate diagnosis is very important for prognosis.The combination of clinical and imaging examination is conducive to early diagnosis.

关 键 词：儿童 异基因造血干细胞移植 淋巴组织增殖性疾病 体层摄影术 X线计算机 

分 类 号：R457.7[医药卫生—治疗学] R816.92[医药卫生—临床医学]